BEFORE ME, the undersigned Notary, ___________________________________________________ [name of Notary before whom affidavit is sworn], on this _________________ [day of month] day of _________________ [month], 20 ____ , personally appeared ___________________________________________________ [name of affiant], known to me, who being by me first duly sworn, on ________ [his or her] oath, deposes and says:
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[set forth affiant's statement of facts]
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[signature of affiant]
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[typed name of affiant]
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[address of affiant, line 1]
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[address of affiant, line 2]
CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
| A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document, to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. |
State of California
County of ___________________
On __________________ before me, __________________________________________________________________________ (here insert name and title of the officer), personally appeared __________________________________________________________________________ __________________________________________________________________________ , who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
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Signature